在患有前列腺癌的男性接受雄激素缺乏治疗后冠状动脉斑块进展:一项随机临床试验
Sagar A Patel1,2, Adithya K Yadalam3, Marly van Assen4
1Department of Radiation Oncology, Emory University, Atlanta, Georgia.
JAMA cardiology
|February 18, 2026
概括
使用GnRH激动剂的雄激素剥夺疗法 (ADT) 在前列腺癌患者中导致冠状动脉斑块的进展比使用GnRH对抗剂更多. 这一发现可能解释ADT相关的心血管风险.
科学领域:
- 心血管医学 心血管医学
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
背景情况:
- 前列腺癌 (PCa) 的雄激素剥夺疗法 (ADT) 与心血管 (CV) 问题有关,但机制尚不清楚.
- 关于GnRH激动剂对抗剂的心血管安全性的研究有相互矛盾的结果.
研究的目的:
- 为了调查ADT是否加速冠状动脉样硬化.
- 为了比较GnRH激动剂对抗剂对冠状动脉斑块进展的影响.
主要方法:
- 一项开放的随机临床试验,涉及非转移性PCa的男性接受盆腔放射治疗和ADT.
- 患者被随机分配,接受GnRH激动剂普罗利德或GnRH抗剂relugolix.
- 冠状动脉斑块体积在基线和12个月使用CT血管造影进行评估.
主要成果:
- 与Relugolix相比,Leuprolide在12个月内与总斑块体积 (TPV) 和非化斑块体积 (NCPV) 的显著增加有关.
- 增加NCPV是斑块进展的主要驱动因素.
- 两组之间化斑块体积 (CPV) 或低衰减斑块体积 (LAPV) 没有显著差异.
结论:
- 在接受ADT的PCa男性中,GnRH激动剂普罗利德加速了冠状动脉斑块的进展,超过了GnRH对抗剂relugolix.
- 这种加速的进展,特别是在非化斑块中,可能是ADT相关的心血管风险的基础.
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